Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases

Abstract

Therapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48 years (range 1-85), there was a predominance of males. Neurological indications included Guillain-Barrè syndrome ( = 22), myasthenia gravis ( = 21), chronic inflammatory demyelinating polyneuropathy ( = 7), polymyositis ( = 3), multifocal motor neuropathy ( = 2), acute disseminated encephalomyelitis ( = 2), neuromyelitis optica ( = 2), multiple sclerosis ( = 2), limbic encephalitis ( = 1) and transverse myelitis ( = 1). TPE was frontline therapy in 57 % of the patients ( = 36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1-66). TPE was done through a central venous access in 97 % and through a peripheral venous access in 3 % of the patients. Human albumin was used as replacement fluid in 49 %, hydroxyethyl starch (HES) in 49 % and fresh frozen plasma in 2 % of the cases. Adverse reactions were recorded in 60 % of the patients. Total ratio of complications in 517 TPE procedures was 10.8 % and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81 %. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.

Therapeutic plasma exchange (TPE) for semi-critical neurology presentations in a non-acute neurology set-up: clinical practice and challenges

“…The observed overall complication rates at our TPE unit (9.4%) were comparable with the recently reported experience in most centres and of the World Apheresis Association (WAA) apheresis registry, ranging from 5% to 12% 10 13 14 19. We observed no complications related to procedures for central venous vascular access, performed under ultrasound-guided by in-house interventional radiologists.…”

“…At initial set-up of our non-acute TPE unit, we performed TPE for various central and PNS disorders, similar to other recently published data from established centres 13–15. With time, we observed an increase in TPE applications for CNS disorders indications.…”

Therapeutic plasmapheresis: an eleven-year clinical experience

“…Of the 13 GBS subjects in our study group, 11 had full recovery of the muscle strength after plasmapheresis and only one subject did not benefit from this procedure. Our study results are similar to the study of 63 patients with neurological disease by Tombak et al [18]. Myasthenia gravis is another common neurologic disorder requiring plasmapheresis.…”

Experience in the Use of Plasmapheresis in Acute Inflammatory Demyelinating Polyradiculoneuropathy Guillain – Barre Syndrome in the Patient With Chronic Hepatitis C Virus Infection and Type 2 Diabetes Mellitus

“…К возможным осложнениям относятся инфекции, кровотечения, дегидратация, нарушения электролитного обмена, а также анафилактические реакции на чужеродный белок (минимальны при применении 5 %-го человеческого альбумина в качестве замещающего раствора), резкая артериальная гипотензия [17]. На основании рекомендаций ASFA от 2010 г., стандартный курс плазмафереза при ОВДП-ГБ включает в себя обмен 200-250 мл плазмы на кг массы тела на протяжении 10-14 дней (5-6 процедур) с замещением 5 %-м раствором альбумина [7,18]. По данным исследования A. Tombak et al [18], замещение плазмы пациента 5 %-м раствором альбумина или гидроксиэтилкрахмала имеет сравнимую эффективность, но при использовании раствора гидроксиэтилкрахмала достигается лучшее соотношение «затраты-эффективность».…”

“…На основании рекомендаций ASFA от 2010 г., стандартный курс плазмафереза при ОВДП-ГБ включает в себя обмен 200-250 мл плазмы на кг массы тела на протяжении 10-14 дней (5-6 процедур) с замещением 5 %-м раствором альбумина [7,18]. По данным исследования A. Tombak et al [18], замещение плазмы пациента 5 %-м раствором альбумина или гидроксиэтилкрахмала имеет сравнимую эффективность, но при использовании раствора гидроксиэтилкрахмала достигается лучшее соотношение «затраты-эффективность».…”